Santos Antonio Alceu dos, Sousa Alexandre Gonçalves, Thomé Hugo Oliveira de Souza, Machado Roberta Longo, Piotto Raquel Ferrari
Portuguese Beneficent Hospital of São Paulo, São Paulo, SP, Brazil.
Rev Bras Cir Cardiovasc. 2013 Mar;28(1):1-9. doi: 10.5935/1678-9741.20130003.
To assess the 30-day and 1-year mortality associated to the red blood cell transfusion after coronary artery bypass grafting surgery. This procedure has been questioned by the international medical community, but it is still widely used in cardiac surgery. Therefore, it is needed more evidence of this medical practice in our country.
We retrospectively analyzed 3,004 patients who underwent coronary artery bypass grafting surgery between June 2009 and July 2010. Patients were divided into two groups: non-transfused and transfused.
The transfused group totaled 1,888 (63%) and non-transfused 1,116 (37%). There were 129 deaths in 30 days, with 108 (84%) in the transfused group and 21 (16%) in the non-transfused (P<0.001). One year mortality totaled 249 distributed in 212 (85%) among transfused patients and 37 (15%) in non-transfused (P<0.001). The adjusted odds ratio for mortality in patients transfused was 2.00 (P=0.007) in 30 days and 2.31 (P=0.003) in 1 year. Even in low risk patients (age < 60 years and EuroSCORE < 2 points), and so with fewer comorbidities, both outcomes, 30 day and 1 year mortality were significantly higher in the transfused patients (7.0% vs. 0.0%, P< 0.001) and (10.0% vs. 0.0%, P< 0.001), respectively.
The perioperative red blood cell transfusions after coronary artery bypass grafting surgery increased significantly the 30-day and 1-year mortality, even after the adjustments for comorbidities and other factors. So, new therapeutic options and autologous blood management and conservation strategies should be encouraged to reduce blood products transfusions.
评估冠状动脉搭桥手术后红细胞输血相关的30天和1年死亡率。这一操作受到国际医学界质疑，但仍在心脏手术中广泛使用。因此，我国需要更多关于这种医疗实践的证据。
我们回顾性分析了2009年6月至2010年7月间接受冠状动脉搭桥手术的3004例患者。患者分为两组：未输血组和输血组。
输血组共1888例（63%），未输血组1116例（37%）。30天内有129例死亡，输血组108例（84%），未输血组21例（16%）（P<0.001）。1年死亡率共249例，输血患者中212例（85%），未输血患者中37例（15%）（P<0.001）。输血患者30天死亡率的调整优势比为2.00（P=0.007），1年为2.31（P=0.003）。即使在低风险患者（年龄<60岁且欧洲心脏手术风险评估系统评分<2分），即合并症较少的患者中，输血患者的30天和1年死亡率这两个结果也分别显著更高（7.0%对0.0%，P<0.001）和（10.0%对0.0%，P<0.001）。
冠状动脉搭桥手术后围手术期红细胞输血显著增加了30天和1年死亡率，即使在对合并症和其他因素进行调整之后。因此，应鼓励采用新的治疗选择以及自体血管理和保存策略以减少血制品输血。
